Commission Reports on Managed
Care's Impact on Individuals with Disabilities or Chronic or
Terminal Illnesses

April 24, 1997

In a report requested by the Legislature in response to
public concerns about the impact of managed care on
individuals with disabilities, chronic conditions or
terminal illnesses, the Minnesota Health Care Commission
found that managed care generally performs as well as more
traditional fee-for-service medicine. The report was based
upon analysis of national and state-based research.

The report also noted, however, that both managed care
and fee-for-service arrangements emphasize medical treatment
and insurance coverage primarily for acute,
episodic conditions; this type of treatment and
coverage is often inadequate to meet the needs of persons
with chronic or long-term conditions. Consequently, both
arrangements can and should be improved to better meet the
needs of persons with disabilities, chronic conditions or
terminal illnesses.

Further, the Commission found no evidence that managed care
has led, as some groups alleged, to the rationing of needed
care for or euthanasia of patients who have the greatest
medical needs or are most vulnerable.

The report also found:

Given the extent to which individuals with
disabilities or chronic or terminal illnesses generally
rely upon the health care system, their concerns and
apprehensions about the system must be better understood
and addressed.

There is often a lack of knowledge of consumer
protections, services, or help available to aid consumers
in navigating the health care system.

The types of consumer protections that apply to an
individual with a disability or chronic or terminal
illness vary depending on the kind of health plan in
which he or she is enrolled. State consumer protection
laws generally do not apply to individuals enrolled in
self-funded employer health plans.

There is considerable disagreement over what
constitutes quality end-of-life care. Desires about the
use of or limits to life-sustaining treatment are often
not well communicated, acknowledged, or followed,
regardless of the type of health care delivery system
used.

Citing Successes and Lack of
Consensus on Health Care, Commission Recommends its Own
Repeal

March 26, 1997

St. Paul, Minn. -- Declaring that many of its goals "have
been accomplished" and citing a lack of consensus on health
care in general and its own role in particular, the
Minnesota Health Care Commission wrote Carlson
Administration officials and several Minnesota legislators
recommending repeal of the Commission, effective July 1,
1997.

The letter reflects discussions at the March 19th meeting of
the Commission and is partly in response to a bill repealing
the Commission introduced by many of the members of the
Legislative Commission on Health Care Access
(L.O.C.).

Commenting on the letter, Chairman John Gunyou
stated:

"The Commission was created during a time of bipartisan
concerns over escalating health care costs and rising levels
of uninsurance. Since then, we have largely accomplished
much of what we set out to accomplish - health care costs
have moderated, the rate of uninsurance has stabilized, and
the number of uninsured children has declined.

As the health care crisis subsided, the consensus among
Commission members and among legislators on cost containment
and universal coverage gradually broke down. Without this
consensus, the Commission found it difficult to do its work
and make a contribution."

We are the victims of our own success. That's not a bad
legacy to leave the state.

This is not to say that the work on health care is finished.
Rather, Commission members believe that the important work
that remains to be done on long-term care, uninsurance and
health technology should be done in different
venues.

The Commission includes representatives of consumers,
employers, providers, health plans, unions and state
agencies.

March 10, 1997

St. Paul, MN - In an annual report to the Legislature,
the Minnesota Health Care Commission found that the state
has made significant progress in reducing the number of
children without health insurance. At the same time,
Minnesota has bucked national trends of increasing
uninsurance rates by holding steady on the general rate of
uninsurance.

"This report shows that Minnesota is making progress in its
efforts to achieve universal coverage, but that more work
must be done," Commission Chairman John Gunyou
said.

Between 1990 and 1995, the number of continuously
uninsured children in the state dropped from approximately
51,000 to 31,000, a 39 percent decrease.
During the same period, the national rate of uninsurance
among children rose.

From 1991 to 1995, when the national rate of uninsurance
for the general population climbed from 13.9 to 15.3
percent, the state's rate of uninsurance remained
stable at between 6 and 9 percent. Two organizations -
the University of Minnesota's Institute for Health Services
Research and the U.S. Census Bureau - conducted studies that
confirmed that the state's uninsured rate held
steady.

Both surveys generally agreed that the uninsured are more
likely to be male, single, younger, less educated, and have
lower incomes.

According to the University's survey, over the same time
period the percent of the uninsured who are minorities more
than doubled, from 5.6 percent of the continuously uninsured
in 1990, to 12.5 percent in 1995. Also, most uninsured
adults were employed. At least 25 percent of the
continuously uninsured were self-employed, and less than 16
percent of the intermittently uninsured were
self-employed.

The Commission recommends that the state expand its
efforts to reach an estimated 86,000 uninsured Minnesotans
who are currently eligible for the MinnesotaCare
subsidized health insurance program but have not yet
enrolled. The Commission also recommends that the state
expand eligibility for the program to single adults and
families without children with incomes up to 175 percent of
federal poverty level, effective July 1, 1997. Based on 1996
federal poverty guidelines, 175 percent of the federal
poverty level is an annual income of $13,545 for an
individual, or an hourly wage of $6.51 for someone working
full time.

A copy of the Commission report, Progress Toward
Universal Coverage: Annual Report 1997, may be obtained
by calling or writing the Commission.